Monday, May 18, 2020
(date guaranteed correct or your money back)
Good morning. The amount of specific and nuanced data emerging is increasing. That means it gets harder, not easier to understand the epidemic. There will be treatments for subsets of patients. There will be testing strategies and tools optimized for only specific points in the course of infection. We may even begin to differentiate activities that feel similar but confer different risks of transmission. We have a long way to go, but I continue to find comfort in the rapid publication of increasingly detailed information.
----
Data Visualization Update
State comparisons:
https://public.tableau.com/views/Coronavirus-ChangeovertimeintheUSA/2_Corona?:display_count=y&:origin=viz_share_link
Rt data
https://public.tableau.com/shared/7FH637YGW?:display_count=y&:origin=viz_share_link
FT data is still the best visualization I have found for country comparisons.
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cumulative=0&logScale=1&perMillion=0&values=deaths
Lots of curves trending down over the weekend, comforting but early still
----------
In follow up to the discussions around the BCG vaccine, there is now patient-level data out of Israel indicating NO reduction in coronavirus risk in BCG-vaccinated young adults.
https://jamanetwork.com/journals/jama/fullarticle/2766182
Here is an older article making the rounds amongst physicians on Twitter. It describes the immune cascade that accompanies ARDS (acute respiratory distress syndrome), the series of signs and symptoms that accompany severe lung infections, irrespective of the cause. I think the question my colleagues are contemplating is whether COVID is unique in some way or, is it a highly prevalent severe pneumonia from which we are learning a lot about the pathophysiology of ARDS?
https://www.karger.com/Article/FullText/453002
Contact Tracing Articles
The CDC has some great information that is the basis of many state, local, and organizational policies. Here is the CDC overview of contact tracing.
https://www.cdc.gov/coronavirus/2019-ncov/php/principles-contact-tracing.html
Here is an article about one Indian State (Kerala) putting contact tracing (and other recommended techniques) to work. Thanks for sharing, Dr. Das!
https://www.theguardian.com/world/2020/may/14/the-coronavirus-slayer-how-keralas-rock-star-health-minister-helped-save-it-from-covid-19
Here is a look at China's contact tracing system.
https://www.ctvnews.ca/health/coronavirus/see-china-s-covid-19-contact-tracing-system-in-action-1.4943352
Here is an early-release (but I believe peer-reviewed journal) article on how contact tracing was used in South Korea to identify an outbreak in a dance fitness class. Aside from appreciating the complexity of contact tracing, as illustrated by Figure 1, I learned that Latin dancing is very popular in South Korea. Or maybe, was.
https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article
One follow-up from Saturday:
Another Twitter thread by an immunologist about his work on the immune response to COVID. Some nice graphics and a great explanation. Enjoy!
https://twitter.com/profshanecrotty/status/1261052353773363200
It appears that antigen testing (direct measurement of coronavirus proteins) is finally approved. Eric Topol highlights this in a tweet along with graphics and a more in-depth discussion.
https://twitter.com/EricTopol/status/1262050316356222982
I discovered two articles offering data-less hope. Both involved treatment options that are being used without clear evidence, no mention of control groups, and provides the underlying impression that these doctors know something others do not. My point of sharing them is to read between the lines - no real data, no controls, no clear physiologic explanation. Gird your mental loins and keep a sharp mind when reading these.
Ivermectin (an anti-parasitic drug) and doxycycline (an antibiotic).
https://tbsnews.net/coronavirus-chronicle/covid-19-bangladesh/bangladeshi-doctors-claim-have-found-effective-drugs-treat
Ozone therapy?!? In Ibiza? This is a commonly recommended therapy in the naturopathic community with very little data to justify its use.
https://www.theolivepress.es/spain-news/2020/04/10/no-new-covid-19-deaths-in-balearic-islands-as-ibiza-clinic-becomes-first-in-spain-to-use-pioneering-ozone-therapy/
Infographic of the day - Infographics gone wrong
When my kids were younger, they were obsessed with Tic Tac Toe. I hated to break it to them that the second move almost always determined the outcome. Essentially, there are three possible opening moves and two or three possible second moves. XKCD took this and made these thoughts more complex. In an infographic. Oy vey.
https://xkcd.com/832/
Here is something far less perplexing (potentially) and cuter. Baby birds.
https://i.redd.it/9gl2gyiojez41.png
And, while we're at it, let's do some fish. Salmon! (but eating, not rescuing)
https://i.redd.it/of7l11uk07z41.jpg
Bonus Round --- Kids projects edition (guess what I was doing this weekend?)
My youngest son has now completed his 8th-grade oral history project. This means that both of my kids have completed their school's project to profile people they find interesting through interviews and a written biographical sketch. They made some pretty interesting choices.
My older son interviewed astronaut Scott Altman. He flew on four missions on the space shuttle (including to repair the Hubble Telescope) and was an F-14 pilot in the Navy. And, if that is not cool enough, he was one of the pilots that performed aerial maneuvers (both flying and gesticulatory) for the movie Top Gun.
https://en.wikipedia.org/wiki/Scott_Altman
http://www.nickcook.net/meeting-tom-cruises-middle-finger-top-gun-shuttle-astronaut-scott-altman/
My younger son interviewed one of the Sudanese lost boys. Manyang Kher survived growing up in a refugee camp, came to the U.S., and has started a successful coffee company that supports the Ethiopian farmers and refugee Sudanese back home. Just after my son submitted his paper, NPR published a comic about Manyang's life as a lesson in resilience. His coffee is delicious, BTW.
https://www.npr.org/sections/goatsandsoda/2020/05/17/854937429/comic-a-lost-boy-a-snake-bite-a-lesson-in-resilience
https://734coffee.com/pages/about
Clean hands and sharp minds,
AW
(date guaranteed correct or your money back)
Good morning. The amount of specific and nuanced data emerging is increasing. That means it gets harder, not easier to understand the epidemic. There will be treatments for subsets of patients. There will be testing strategies and tools optimized for only specific points in the course of infection. We may even begin to differentiate activities that feel similar but confer different risks of transmission. We have a long way to go, but I continue to find comfort in the rapid publication of increasingly detailed information.
----
Data Visualization Update
State comparisons:
https://public.tableau.com/views/Coronavirus-ChangeovertimeintheUSA/2_Corona?:display_count=y&:origin=viz_share_link
Rt data
https://public.tableau.com/shared/7FH637YGW?:display_count=y&:origin=viz_share_link
FT data is still the best visualization I have found for country comparisons.
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cumulative=0&logScale=1&perMillion=0&values=deaths
Lots of curves trending down over the weekend, comforting but early still
----------
In follow up to the discussions around the BCG vaccine, there is now patient-level data out of Israel indicating NO reduction in coronavirus risk in BCG-vaccinated young adults.
https://jamanetwork.com/journals/jama/fullarticle/2766182
Here is an older article making the rounds amongst physicians on Twitter. It describes the immune cascade that accompanies ARDS (acute respiratory distress syndrome), the series of signs and symptoms that accompany severe lung infections, irrespective of the cause. I think the question my colleagues are contemplating is whether COVID is unique in some way or, is it a highly prevalent severe pneumonia from which we are learning a lot about the pathophysiology of ARDS?
https://www.karger.com/Article/FullText/453002
Contact Tracing Articles
The CDC has some great information that is the basis of many state, local, and organizational policies. Here is the CDC overview of contact tracing.
https://www.cdc.gov/coronavirus/2019-ncov/php/principles-contact-tracing.html
Here is an article about one Indian State (Kerala) putting contact tracing (and other recommended techniques) to work. Thanks for sharing, Dr. Das!
https://www.theguardian.com/world/2020/may/14/the-coronavirus-slayer-how-keralas-rock-star-health-minister-helped-save-it-from-covid-19
Here is a look at China's contact tracing system.
https://www.ctvnews.ca/health/coronavirus/see-china-s-covid-19-contact-tracing-system-in-action-1.4943352
Here is an early-release (but I believe peer-reviewed journal) article on how contact tracing was used in South Korea to identify an outbreak in a dance fitness class. Aside from appreciating the complexity of contact tracing, as illustrated by Figure 1, I learned that Latin dancing is very popular in South Korea. Or maybe, was.
https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article
One follow-up from Saturday:
Another Twitter thread by an immunologist about his work on the immune response to COVID. Some nice graphics and a great explanation. Enjoy!
https://twitter.com/profshanecrotty/status/1261052353773363200
It appears that antigen testing (direct measurement of coronavirus proteins) is finally approved. Eric Topol highlights this in a tweet along with graphics and a more in-depth discussion.
https://twitter.com/EricTopol/status/1262050316356222982
I discovered two articles offering data-less hope. Both involved treatment options that are being used without clear evidence, no mention of control groups, and provides the underlying impression that these doctors know something others do not. My point of sharing them is to read between the lines - no real data, no controls, no clear physiologic explanation. Gird your mental loins and keep a sharp mind when reading these.
Ivermectin (an anti-parasitic drug) and doxycycline (an antibiotic).
https://tbsnews.net/coronavirus-chronicle/covid-19-bangladesh/bangladeshi-doctors-claim-have-found-effective-drugs-treat
Ozone therapy?!? In Ibiza? This is a commonly recommended therapy in the naturopathic community with very little data to justify its use.
https://www.theolivepress.es/spain-news/2020/04/10/no-new-covid-19-deaths-in-balearic-islands-as-ibiza-clinic-becomes-first-in-spain-to-use-pioneering-ozone-therapy/
Infographic of the day - Infographics gone wrong
When my kids were younger, they were obsessed with Tic Tac Toe. I hated to break it to them that the second move almost always determined the outcome. Essentially, there are three possible opening moves and two or three possible second moves. XKCD took this and made these thoughts more complex. In an infographic. Oy vey.
https://xkcd.com/832/
Here is something far less perplexing (potentially) and cuter. Baby birds.
https://i.redd.it/9gl2gyiojez41.png
And, while we're at it, let's do some fish. Salmon! (but eating, not rescuing)
https://i.redd.it/of7l11uk07z41.jpg
Bonus Round --- Kids projects edition (guess what I was doing this weekend?)
My youngest son has now completed his 8th-grade oral history project. This means that both of my kids have completed their school's project to profile people they find interesting through interviews and a written biographical sketch. They made some pretty interesting choices.
My older son interviewed astronaut Scott Altman. He flew on four missions on the space shuttle (including to repair the Hubble Telescope) and was an F-14 pilot in the Navy. And, if that is not cool enough, he was one of the pilots that performed aerial maneuvers (both flying and gesticulatory) for the movie Top Gun.
https://en.wikipedia.org/wiki/Scott_Altman
http://www.nickcook.net/meeting-tom-cruises-middle-finger-top-gun-shuttle-astronaut-scott-altman/
My younger son interviewed one of the Sudanese lost boys. Manyang Kher survived growing up in a refugee camp, came to the U.S., and has started a successful coffee company that supports the Ethiopian farmers and refugee Sudanese back home. Just after my son submitted his paper, NPR published a comic about Manyang's life as a lesson in resilience. His coffee is delicious, BTW.
https://www.npr.org/sections/goatsandsoda/2020/05/17/854937429/comic-a-lost-boy-a-snake-bite-a-lesson-in-resilience
https://734coffee.com/pages/about
Clean hands and sharp minds,
AW
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